A Clinical and Pathological Analysis of Snake Bites on the Panama Canal Zone

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Abstract
Summary Nearly all poisonous snake bites in the Canal Zone and Panama are by the genus Bothrops, and the majority are by B. atrox. The incidence is low and the mortality in 23 cases in which there was evidence of venom poisoning was 30.4 per cent. Bothropic venom may produce hemorrhagic tendencies, hemolysis and proteolysis, although all these effects may not be manifest in a given case. Anticoagulation and bleeding, with hemolysis, usually began in the series reported within 20–24 hours after the bite, and began to clear in about 48 hours. The degree to which antivenin and transfusions affected this sequence is not known. Proteolysis was not an important factor at this stage. Seven fatal cases are reported, with shock and hemorrhage into the central nervous system as the principal causes of death. One severe case which recovered is presented in detail. Suggestions are given as to the best form of treatment, based on these cases and those reported by other authors. Certainly the unknown aspects of venom poisoning, the factors affecting shock production and the evaluation of therapeutic measures need more investigation and accurate reporting by those in a position to do so.
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